CTE Found in 99 Percent of Former NFL Players Studied

Data suggest disease may be more common in football players than previously thought

"The fact that we were able to gather so many instances of a disease that was previously considered quite rare, in eight years, speaks volumes," says Ann McKee, director of BU’s CTE Center. Photo by Asia Kepka

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A new study suggests that chronic traumatic encephalopathy (CTE), a progressive, degenerative brain disease found in people with a history of repeated head trauma, may be more common among football players than previously thought. The study, published in July in the Journal of the American Medical Association (JAMA), found CTE in 99 percent of brains obtained from National Football League (NFL) players, as well as 91 percent of college football players and 21 percent of high school football players.

“The data suggest that there is very likely a relationship between exposure to football and risk of developing the disease,” says Jesse Mez, a School of Medicine assistant professor of neurology and lead author on the study.

“The data suggest that there is very likely a relationship between exposure to football and risk of developing [CTE],” says lead author Jesse Mez. Photo by Cydney Scott

The study has several important limitations, most notably the lack of a control group, and selection bias in the brain collection itself—families of players with symptoms of CTE are far more likely to donate brains to research than those without signs of the disease. Despite these limitations, researchers note that the study—the largest and most methodologically rigorous CTE case series ever published—offers important information and direction for further research.

“The fact that we were able to gather so many instances of a disease that was previously considered quite rare, in eight years, speaks volumes,” says corresponding author Ann McKee, a MED professor of neurology and pathology and director of BU’s CTE Center. “There’s just no way that would be possible if this disease were truly rare.”

“I think the data are very surprising,” she adds. “We’ve sort of become accustomed to it, but it is very shocking.”

For the study, the researchers began with the donated brains of 202 football players. Pathologists, knowing nothing of a patient’s history or symptoms, examined each brain for evidence of CTE. At the same time, clinicians—blinded to each brain’s pathology—used medical records and interviews with family members to collect detailed information about each patient’s medical history and symptoms. The group met for regular consensus meetings, where the pathologists and the clinicians presented their findings. They limited the study to football players, providing a somewhat homogeneous sample.

Of the 202 brains studied, the group diagnosed 177 with CTE, including 110 of 111 from the NFL players (99 percent); 7 of 8 from the Canadian Football League (88 percent); 9 of 14 semiprofessional players (64 percent); 48 of 53 college players (91 percent); and 3 of 14 high school players (21 percent). (The group also studied the brains of two players who were not yet in high school, neither of whom was diagnosed with CTE.) The brains of former high school players showed only mild pathology, while the majority of college, semiprofessional, and professional players showed severe pathology.

Mez notes some puzzling findings from the study. Most striking, the researchers found clinical symptoms such as depression, anxiety, disinhibition, memory loss, and other mood and behavior impairments even in patients with fairly mild CTE pathology. “Why do you still see symptoms even without that much CTE pathology?” asks Mez. “It suggests that there might be even more going on than just the tau pathology; there might be other things that we need to look at, like inflammation or axonal injury, or there might be regions of the brain that we’re not looking at sufficiently.”

Dave Duerson, a former safety for the Chicago Bears, committed suicide in 2011 at age 50. His suicide note read, “Please, see that my brain is given to the NFL’s brain bank.” McKee analyzed his brain and diagnosed moderately severe CTE. Duerson’s brain is among the 202 included in a study published in JAMA. Photo by Owen C. Shaw/Getty Images

The findings also suggest that there may be other environmental factors at play, like substance abuse, other head traumas, or a genetic component. Mez says that clues may come from outliers in the study, like the one NFL brain that did not show evidence of CTE or the brains from high school players that did.

“Those people are probably genetically protected from this disease or they’re genetically predisposed to it, depending on which extreme you’re looking at,” says Mez. “I think you can certainly learn a lot from them. And as we move forward and we collect more of those extremes, they will be really informative.”

The researchers emphasize that the data represent a new tool for scientists. “This is an enormous advance in a resource, because we have developed this brain bank of frozen and fixed tissue on these individuals who have been affected by this disease,” says McKee. “Our goal is to try to understand the disease from its earliest beginnings in the brain, what molecular pathways are involved, how it spreads, which regions it affects most severely—all to give us ideas how to diagnose this disease during life, and also to give us information about how to treat it.”

5 Comments

What is the total number of people who played football, so the reader could get a sense of the percentage the 202 brains studied is relative to the total number of candidates. The 99% found in players studied in title gives the article a chicken little mentality or a tabloid like feel. Any plans to study the brains of other athletes or people who work regular jobs? How about rates between genders?

I think you should also include the percentage of the number studied to the total number of people who played football. The 99% of brain STUDIED headline gives a chicken little mentality or tabloid like feel to the article. Any plans to study of the brains of people who played other sports or the brains, or people of other employment (construction workers vs. people who work desk jobs etc…)? Any distinction between genders?

I’m not surprised. You could expect these results if you look at the way these guys wear their helmets. As a former seller of automobile racing equipment, we would require that a helmet be tight on the head ( marginally uncomfortable ). I can’t imagine these loose helmets give much protection.